Abstract 11662: Efficacy And Safety Outcome Of Intravenous Vernakalant For Recent-onset Atrial Fibrillation: A Systematic Review And Meta-analysis

Abstract

Introduction: Vernakalant hydrochloride is a relatively new atrial-selective antiarrhythmic approved in >40 countries to pharmacologically cardiovert patients with recent-onset atrial fibrillation (ROAF). Due to safety concerns, it is yet to be approved in the USA. Objectives: To determine the effectiveness and safety of vernakalant in patients with ROAF. Methods: We systematically searched PubMed, EMBASE, Ovid MEDLINE, and CENTRAL from inception to December 2022 for studies that compared intravenous vernakalant to another drug(s) or placebo in patients with ROAF (onset ≤7 days). The pre-specified efficacy endpoint was conversion to sinus rhythm within 90minutes of administering interventions. Safety outcome of interest was mortality rate. Random-effects model meta-analysis was performed on extracted quantitative data. Results: 886 patients got vernakalant, 353 received placebo, and 401 got an antiarrhythmic agent. Vernakalant was significantly superior to placebo (conversion rate: 49.5% vs 6.2%, OR: 14.94, 95% CI: 7.18-31.07, P<0.001, I 2 : 49%), Flecainide (72.3% vs 53.8%, OR: 2.44, 95% CI: 1.46-4.06, p<0.001, I 2 : 0%), Amiodarone (55.7% vs 8.5%, OR: 17.42, 95% CI: 7.75-39.13, p<0.001, I 2 : 0%), but not Ibutilide (62.4% vs 47.3%, OR: 1.77, 95% CI: 0.61-5.08, p=0.29, I 2 : 67%) in efficacy endpoint. In the vernakalant group, there was significantly lower incidence of ventricular arrhythmia (OR:0.65, 95% CI: 0.45-0.95, p=0.027) but higher incidence of bradycardia (OR:8.58, 95% CI: 4.69-15.67, p<0.0001) and dysgeusia (OR:14.51, 95% CI: 7.03-29.95, p<0.0001). No significant difference in mortality rate between vernakalant and other groups combined (OR: 2.51, 95% CI: 0.26-24.21, p=0.427). Conclusions: This hypothesis-generating study showed that intravenous vernakalant, though associated with a higher incidence of bradycardia and dysgeusia, is superior to placebo, Flecainide, and Amiodarone not Ibutilide in converting ROAF to sinus rhythm.